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A Clinician Scientist attending answering questions

Discussion in 'Physician Scientists' started by Fencer, Jul 23, 2011.

  1. Fencer

    Fencer MSTP Director
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    After a little over a year out, I am happy to take few questions as a practicing clinician scientist (MD PhD w VA Merit/NIH funding and clinical neurologist).

    For applicants: read the FAQs, they have a lot of useful and accurate information. High MCATs/GPA increase your likelihood to get in, but even for a MCAT of 40, there is a 3-8% chance of not getting in. Why? Poor amount of clinical shadowing, not sufficient commitment to research, something bad on your application (i.e.: DWI, etc.), terrible interview, poor GPA, etc. Clearly, if you repeat these odds across many programs, you get in somewhere.

    For MD PhD students: enjoy the ride; these are great years. Although you will not make as much as your exclusively clinical colleagues (~ 30-40% less), you will do well economically (better than ok), and retire with few $ M (if you live within your means, contributing to your university's 401K). The most important thing is that you will get to do what you love, get paid for it, and leave a great "footprint" in Medicine and Science.
     
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  3. Neuronix

    Neuronix Total nerd
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    Fencer is legit guys :thumbup:. You should come by more often. :)
     
  4. pradeepk

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    Hi I'm still a pre-med student but I am still confused about the career of an md/phd even though there are tons of forums about it. People say that its 80/20, but does that mean you are at a university running a lab, and then you go to the hospital at other times? I really love research, and want to pursue it in the future, but I also want to be a clinician and connect with patients.
     
  5. EsseQuamVideri

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    Thanks for donating your time! We really appreciate it and as Neuro said, it'd be great to see you here as much as possible :xf:

    - Can you comment on the extent that networking has helped your career (or one's in general)? i.e. did your university-based connections help you with research collaborations, residency placement, tenure-track faculty positions?

    - Also, how challenging was the financial side of MD/Ph.D training? Could you live reasonably (modestly), save for retirement, pay off ugrad debt, start a family?

    -(General) Any advice for current applicants?

    Much appreciated!
     
  6. Fencer

    Fencer MSTP Director
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    The 80/20 model is the most efficient to be able to compete against PhDs doing 100/0. However, I and many others, were able to make it at 50/50. You can also switch back and forth with a year of 20/80 followed by a couple of 80/20. One of the most important issues is how close is the "focus" of your research and clinical activity. Are you studying mechanisms of disease in models while taking care of the human model?
    The most critical aspect is whether you have no other option (self-imposed due to your inner desire) than doing what you want. The 50/50 model is inefficient, you will struggle, and but eventually you can succeed.
     
  7. Fencer

    Fencer MSTP Director
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    Network:
    It is very important to network in your professional society more than at your own university. You might move places, or things might not work on your first university position. The guys who will write your letters of recommendation for promotion, indicating national and international reputation, will be the network from your professional society. Now, this does not mean that you don't do "service" or "network" at your institution. It means that it has lesser value to serve in website committee of your institution as compared to the same committee in your professional society.

    Economics:
    It is hard to live within your means at all levels. It requires discipline. I don't drive what my private practice friends do, but I live "the dream"... Have a great house, pool, 4 cars (2001-5), kids in private colleges. Currently, I have loans for $250K (incl. mortages, and student loans for my kids), but my net ownership is over $1M in stuff at 15 yrs from 1st real job. I have 20-25 yrs, and will retire w over $10M. We had our kids at 4 and 2 years before starting residency, and for most of my career, we had a single income. ANY Clinician Scientist will do well, just focus upon doing great at the next step. I posted before salaries from AAMC. The clinician scientist at clinical departments will make about at 25 percentile or so, until you become "really big". I am at 50 percentile for my specialty, and know a few CS at 75+.

    Advise:
    Have a clear commitment to science, but make you that you have done at least minimum sufficient clinical shadowing (~100-200 hrs). If you have holes on your application (tank a year in UG), explain them, turn them into constructive steps. Enjoy the process...
     
  8. shishka32

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    Can you comment on your lifestyle throughout training and now as an attending/PI? Hours worked, days per week in the lab vs. clinic, call, working at home, etc.

    Thanks!
     
  9. Fencer

    Fencer MSTP Director
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    Loaded question! I did residency before the 80 hr rule, and as Attending, I did get to coach my kids during late elementary/middle school.

    Hours
    Training: 110-80 hrs/wk (every yr 10 hrs/wk less except no diff betw. PGY 1 or 2)
    Attending: 60-70 hrs/wk (except 2/8 wks when double up attending time in 2 services = ~80-90). I have 1 day/wk of longitudinal clinic.

    Call
    Always from home, for 2/8 weeks. During those 2/8 weekends, round for 4-6 hrs each weekday.

    Working from home
    At VA, you have to be physically there. At Univ., you can write for 2-3 days if not on clinical service. During early mornings, I stay at home to work on email, papers, grants, etc. I drive to work after rush traffic. On the other hand, I stay at work a bit longer, missing the traffic back home.
     
  10. caliQ

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    Ooh my first post, how exciting :cool:

    I'm assuming your research is relating to neurology/neuroscience--do you think that the neuro market for young physician-scientists is becoming overly saturated?

    I ask because that's the sort of research I'm hoping to go into (nothing too specific yet, I'm just going into my sophomore year in undergrad). I've noticed a few sort of off-hand comments here at SDN and at some other sites (can't think of them off the top of my head) about "wow what's with neuroscience, seems like everyone's into it these days." Personally, I've also had anecdotal experience with what seems like quite a few students in my college/HS planning on going into neuro. Obviously not the most accurate measure but hey, it's what I've got :D
     
  11. ablavar

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    Any tips for cutting corners in the time it takes to land a faculty position?
     
  12. Fencer

    Fencer MSTP Director
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    I am a clinical Epileptologists and a bench and clinical scientist in Epilepsy.

    There is no "overly saturated" market for Neurologists or Neuroscientists. Today, we have funding rates in the low 10s for NINDS, but not at earlier stages of a Clinician Scientist's career. Perhaps, they don't need more neurologists in the Boston area (highest density in the country), but there are many places where CS Neurologists are been actively recruited.

    Funding goes on cycles. In the 80s, there was a crisis. In the 90s, at another point, there was a crisis. In the 00s, there was one that still lingers. Salaries for Academic Neurologists start at the 110-120K, raising to 140-160K at Associate, and 180-210K for Professor. Bench Neurologists are typically at the lower side of the scale.
     
  13. Fencer

    Fencer MSTP Director
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    Publish, publish, publish... You need to have at least a few papers (2-6) to be appointed Assistant Professor. The more papers, the better journals, the faster is to get a position.

    Keep in mind that positions are available because of a particular need at the institution at a given particular time. If there is a single medical school in your dream state, you might have to wait for a long time if there is no need in your area of expertise.
     
  14. EsseQuamVideri

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    Fencer,

    As far as publications. Do thesis pubs vs. post-doc pubs count more/less? If you have a very productive graduate school stint say, with 4 first author publications, would that give you an advantage as a post-doc looking for tenure-track positions or does it really matter only what you do during your post-doc years?
     
  15. sluox

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    Wait, how do you get the math of $1M at 15 years and $10M at 30 years? I mean I know there's compound interest, but even George Soros doesn't get that kind of return.

    By the way, I appreciate you being so candid with the financial stuff, especially when your identity is not a complete secret.
     
  16. PfNO22

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    Dude, binary exponential interest.
     
  17. tortuga87

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    please elaborate...
     
  18. Silverfalcon

    Silverfalcon Do It
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    Did you do postdoctoral work? If so, how many years and in what areas?
     
  19. Chimneysweep

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    I'm curious, Fencer, does this close focus apply to your research?
     
  20. Fencer

    Fencer MSTP Director
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    Guys,

    Some of you know who I am. If you do, please don't spread that if you want me to give "candid" advise particularly if you know my current role.

    Regarding how you get there, you forget that currently I have a lot of expenses, two kids in private college, two mortgages at 15 years each, etc., and I still have 20-25 years (hopefully) ahead of me with greater earning potential with less expenses. Furthermore, I have done well (and poorly 2000-02, 2008-09) investing. I recovered all overall losses because I did not panic. I have maximized matching contributions, roth IRAs, deferred compensation, earned a VA pension (progressively getting bigger), etc., but most importantly I lived within my means. A lot of information is public in my state if you know how and where to look for it.

    Now, the question you raised, sluox. 1 M at 15 yrs (at this stage: considerable lower income and greater proportional/real expenses, but longer ability to compound) to 10 M at retirement at year 35-40 from completion from training (at this stage: earning progressively more while having decreasing liabilities). I said that I expect to work for 20 -25 additional years (from now - starting year 15). That is a lot of money on the table with ability for investments with discretionary monies.

    Silverfalcon, Did you do postdoctoral work? If so, how many years and in what areas?

    I submitted a HHMI that got great reviews but not funded, I jumped at first real job available to start supporting my family.
     
  21. Fencer

    Fencer MSTP Director
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    Very much...

    I have to read a smaller amount of literature, attend less meetings, etc. My bench to bedside, or bedside to bench occurs within my head. My ACGME program, clinical practice, clinical research, clinical teaching, laboratory research, and graduate teaching is all about the same disease. I study bench and clinical mechanisms of that disease. For example, I have an IRB protocol and a IACUC protocol about a hypothesis driven evoked response from electrical brain stimulation that uses essentially the same protocol.
     
  22. Neuronix

    Neuronix Total nerd
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    Please note that SDN moderators are contractually bound to not reveal identities or identifying information of SDN users.

    The SDN Terms of Service is similarly explicit. SDN users who identify other users are subject to post removal and ban. The only exception is to repeat what has already been said by the poster. i.e. We can say you're a Neurologist for example. People can say a lot more about me because I have said a lot about myself in the open on SDN.

    As always, we want to promote a safe environment for mentors who volunteer their precious time in this very important way--reaching those who probably would not receive proper advising otherwise.
     
  23. echod

    echod Junior Member
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    Could you elaborate on how much your spouse helps out with family finances? Does she earn close to what you are making? Would your standard of living be very different if she was a stay at home mom? In terms of the private school tuitions, loans, how much $ you expect to have when you retire, etc. Thanks!
     
  24. leavitt

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    1) The kind of research that an MD does - how is it different from the sort of research an MD-PhD does? 2) If an MD wants to do research at a research university without getting a PhD, what does he need to do?
     
  25. Fencer

    Fencer MSTP Director
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    Could you elaborate on how much your spouse helps out with family finances?
    She runs the finances, runs our rental property, and photography is her passion. Essentially we are a single income family.

    Would your standard of living be very different if she was a stay at home mom?
    She became a stay home mom as soon as we were able to afford it.

    how much $ you expect to have when you retire?
    I indicated that before, I expect to retire sometime between 67-72 with 10 M.
     
  26. Fencer

    Fencer MSTP Director
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    1) This is an interesting question. It depends of the depth of "post-doc" time that a plain MD does. Jumping to bench would be difficult unless 3-4 years of work (essentially earning the PhD. Doing a clinical trial or translational research would be much easier but it will require 1-2 years. During residency or MD, you could take courses for a masters degree in clincial investigation.

    2) see above. If clinical, taking courses and doing a project on clinical translational reseach would be one way.
     
  27. sluox

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    So I just did a calculation, and actually if you save 50k a year on a base of 1 M for 25 years, at 9% interest (reasonable S&P average), you DO grow to > 10M. The main issue though is that you didn't factor in the inflationary factor, unless you can beat the market consistently. So conservatively if the inflation is 3%, the real end growth is ~ 7M in terms of purchasing power. So you can realistically expect somewhere between 5-10M in inflation-adjusted purchasing power to retire on. This savings rate though is still really kind of high. Given that even with full 401k, you can only save 16k/yr per person, you still need to save 30k after tax. This is more than 25% on a 200k salary...it's somewhat ambitious, don't you think? Also, that 1M at 15 years base accounted for a substantial amount of the growth...Let's see, say I graduate residency at 35, is it really likely that I would have 1M in net savings at the age of 50? Are you counting your primary residence? Also, isn't retiring at 67-72 a bit late? (These are rhetorical questions, you shan't feel obligated to answer them.)

    On the other hand, I think even if you "only" have ~ 1-5M of real purchasing power to retire on, you should be living a fine life after retirement, and that seems pretty much risk free.

    The bottom line is, no matter how you do the math, you should not have to worry about money if you become a clinician-scientist. The only exception could be those who live in very high cost areas with one salary. Keep in mind that even with the bottomed out salary of 150k, with reasonable financial planning, people can save 1-5M at retirement.

    The other thing that came out of this little exercise is that if you bump into a retirement age doctor, and if nothing really horrible happened to him, expect him to have ~5-10M in his pocket--this might include primary residence though. You can kind of gear his consumption pattern based on that fairly reasonable assumption. This is likely why doctors are still, by and large, wealthy.

    P.S. I won't spread anything.
     
    #26 sluox, Jul 31, 2011
    Last edited: Jul 31, 2011
  28. MysticCrusader

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    Fencer, would years during fellowship count toward those 3-4 years? i.e. does the work have to be in the context of taking time off from clinical work fully and pursuing the post-doc? Are there cases where clinicians will be granted some sort of protected time even though they don't have a PhD?
     
  29. Fencer

    Fencer MSTP Director
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    My first real "Attending" job was as I a few months before I turned 34. I am not yet 50 and have been reasonable lucky with investments. 401K does not include properties. Another thing, the 16K is for your contribution (not for the matched contribution). If you have 1:1 match, your 16K are truly 32, but 16 against your salary. Retirement age of 67 is what my generation (and probably yours) expect. 65 would be long gone.
    If you enjoy doing this and there is no mandatory retirement, I don't see why rather than retirement, you continue beyond 67 at a half-time earning contributions and health insurance for a few extra years.
     
  30. Fencer

    Fencer MSTP Director
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    It depends, if this is done in a research residency where half of the time you are doing research, the half-time in research would count against the 3-4 yrs. If you are talking about a clinical fellowship, it does not count.
     
  31. user003

    user003 lab slave

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    Fencer (by the way I fenced foil during high school and my undergrad :D)

    I am going to be applying in 2012 to med school, but I am worried that if I didn't get accepted into my top schools, I wont be able to do well or enjoy my education. How was your experience regarding which school you attended?
     
  32. PfNO22

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    :thumbdown:
     
  33. Choculitis

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    Thanks for that insight, dude.
     
  34. kathrasis

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    Fencer, do you know of any MD/Phd surgeons? How is their lifestyle like?
     
  35. Choculitis

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    I would like to know this too. :thumbup:

    On a related note, roughly how much of your time should be spent on research to justify an MD/PhD? I know that the goal is 80/20, but what about, say, 40/60 or 50/50. My plan now is to do surgery (probably plastic or orthopedic), but I don't think it's plausible to only spend 1 day a week doing surgery. I know that I would probably not wanted to be operated on by someone who does that little surgery.

    Also, what sort of research opportunities are there for people who don't want to run their own lab but still want to be involved in basic science research. So, let's say I only do an MD but still want to do 1/3rd research. Could I run a basic science lab along with someone who does research full time?

    Thanks!
     
    #34 Choculitis, Aug 2, 2011
    Last edited: Aug 2, 2011
  36. Fencer

    Fencer MSTP Director
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    I do know some. It is challenging particularly because you have to practice your "art or craft" to stay at top of the game. However, there is always that special one who is amazingly good at both. Those are extremely few. Lifestyle, surgeons earn more, and eventually they are able to create enough revenue to support a PhD scientist running their lab.
     
  37. Fencer

    Fencer MSTP Director
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    Surgeons are not able to do 80/20 but only for a couple of years. For most of their career, if they stay in science, they do 50/50 with a project that is closer to their area of expertise. For example, neurosurgeon and TBI or vasospasm research; vascular and endothelial research; ortho and biomaterials; etc.
     
  38. Choculitis

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    So if I want to do that is it worth doing a PhD?
     
  39. kathrasis

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    Just wanted to drop by and say thanks for answering my question, fencer. Appreciate it.
     
  40. Fencer

    Fencer MSTP Director
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    Do you want to try with out the PhD training? That would be a recipe for disaster. The few surgeons that I have seen succeeding doing both at 50/50 have PhDs. The overwhelming majority of surgeons without that training eventually drift into clinical practice +/- clinical research.
     
  41. Choculitis

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    Okay, thanks for the help!
     
  42. Guero

    Guero 2QT2Bcis Plaidapus
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    First, I'd like to thank you for taking the time to answer our questions. I've been set on applying to MSTPs for years, and finally get my chance this year, but would love to get a better feel for what lies ahead: Would you mind commenting on the intricacies of your involvement in the lab as a PI?

    For instance, do you actually get to do any benchwork? So many of my mentors seem chained to their offices, resigned to grant-writing interspersed with supervisory meetings with lab members and absolutely no hands-on involvement, not even to demonstrate appropriate patch-clamping or amperometry techniques. (My observations include both dual degree physicians scientists and PhD-only scientists at a top 20 academic medical center.)

    Thanks again in advance and good luck to those applying this season.
     
  43. Fencer

    Fencer MSTP Director
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    Vanderbilt?

    A top academic center forces up the competition for efficiency. The 80/20 model is more efficient than 50/50. It is easier to become a middle size fish if you are in a middle size pond than in a big size pond with lots of competition.

    I get to review slides, results, etc. Very rarely, I do experiments myself but every few months, I have to show the techniques. It is inevitable that you become the best in the group to be able to do a particular skill, write papers and grants. Critical thinking takes a much longer period of time to develop.
     
  44. PfNO22

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    Most MD/PhDs I know are 100/0. They seem to be pretty happy with that.
     
  45. Guero

    Guero 2QT2Bcis Plaidapus
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    Hmm, maybe I should be more careful about posting my town and MD/Apps profile if I dole out thinly veiled school references in my posts. I'd say you're spot on about those critical thinking skills, lol.

    Anyway, thanks for the reply. I'm glad to hear you actually get to run a few experiments every now and then. Take care.
     
  46. Fencer

    Fencer MSTP Director
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  47. PfNO22

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    Dr. Fencer,

    How did your research and clinical interests evolve during your education? At what point were you sure about your directions?


    A lot of the programs I applied to that I ranked at the top of my list seem very similar. I think I would get a top notch education and have good prospects after school at any of them. What sets schools apart? What should I be sure to find out during interviews? How long can I stay in the same place??

    What advice would you give to me considering that during this process I'm expressing my interest in pursuing training in non-bench population science? I've at least verified that I applied to schools that support this.
     
    #46 PfNO22, Aug 17, 2011
    Last edited: Aug 17, 2011
  48. Fishin316

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    Dr. Fencer,

    Did you do a post-doc? Is that something very common for MD/PhDs' to do or do MD/PhDs' tend to gain that kind of training during fellowships?
     
  49. Fencer

    Fencer MSTP Director
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    Obviously, not a single recipe works. Each of us is an anecdote, but certain paths are more common. How long can you stay at one place? well it depends... some stay put their entire career, some move after each step. There are pros and cons. The biggest issue is whether you are pursuing excellence along each of the steps.

    Regarding your questions about me:
    I got into my current field about a couple of years prior to doing my PhD because I was fascinated with brain plasticity. My interest on that was since about 10 years of age, but it was not emerging understanding until I taken neuroscience in pre-med and read the first edition of Kandel's (cover to cover). At that point, I was sure about my general field but unsure whether I was able to approach it as neurosurgeon, neurologist, or psychiatrist. I had a strong preference for neurology but until I did clinical rotations I wasn't 100%. I am working as PI on stuff I began as graduate student over 20 years ago. But during residency, I still kept options open within neurology, eventually came back into the same condition. I have been funded for bench, translational, clinical trials, clinical population and health care outcomes but all within my field. It is not the most efficient model but I continue to have fun...

    Comparing schools:
    What set places apart is Mentorship. It starts from the program director (PD)all the way down to older students in the program mentoring younger students.

    The two most important interviews are the student(s) and the program director. Given your interest, you should be applying to programs with CTSA grants looking for a certificate or a PhD in translational research science, which could be earned with that type of research.

    Questions to ask:
    Are the students happy?
    Is the program responsive to the needs of students?
    Do you get help submitting grants from your peers and faculty?
    What is the vision of the PD?
    Are there sufficient number of PIs in my area of interest?
    Am I required to submit a grant (that is actually good)?
    What if it is not funded? Are you still funded by the program?
    Are you all years of the program funded?
    If MSTP, is there a process for selecting a MSTP slot?
    Are you able to participate in the NIH PhD away program (limited to MSTP and CTSA)
    What are the promotion guidelines within the program?
    Is there a process for grievances?
    Is the PD your advocate?
    Do the students feel that the PD is a good mentor for career development?
     
  50. Fencer

    Fencer MSTP Director
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    I did not, but I was supporting a family of 4 and needed a real job.

    Would it have been better? Yes. Most people returning to bench research after residency do a post-doc, which could be part of your fellowship.
     
  51. Fencer

    Fencer MSTP Director
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    bump .....
     

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